Baseline State Research Articles

Metrnl regulates cognitive dysfunction and hippocampal BDNF levels in D-galactose-induced aging mice.

Aging is one of the main risk factors for cognitive dysfunction. During aging process, the decrease of brain-derived neurotrophic factor (BDNF) and the impairment of astrocyte function contribute to the cognitive impairment. Metrnl, a neurotrophic factor, promotes neural growth, migration and survival, and supports neural function. In this study, we investigated the role of Metrnl in cognitive functions. D-galactose (D-gal)-induced aging model was used to simulate the process of aging. Cognitive impairment was assessed by the Morris water maze test. We showed that Metrnl expression levels were significantly increased in the hippocampus of D-gal-induced aging mice. Metrnl knockout did not affect the cognitive functions in the baseline state, but aggravated the cognitive impairment in the D-gal-induced aging mice. Furthermore, Metrnl knockout significantly reduced hippocampal BDNF, TrkB, and glial fibrillary acidic protein (GFAP) levels in the D-gal-induced aging mice. In the D-gal-induced aging cell model in vitro, Metrnl levels in the hippocampal astrocytes were significantly increased, and Metrnl knockdown and overexpression regulated the BDNF levels in primary hippocampal astrocytes rather than in neurons. We conclude that Metrnl regulates cognitive functions and hippocampal BDNF levels during aging process. As a neurotrophic factor and an endogenous protein, Metrnl is expected to become a new candidate for the treatment or alleviation of aging-related cognitive dysfunction.

Unexpected Death of a Mannequin: A Mixed Methods Pilot Study on Relationships of Stress, Anxiety, and Resilience on Learning Outcomes

BackgroundAlthough simulation increases competencies in end of life care, unexpected death simulations are often avoided due to student stress and anxiety. This pilot study aimed to determine a protocol for studying relationships of stress, anxiety, and resilience on student learning outcomes during an unexpected death simulation. MethodA mixed methods design used demographics, resilience scores, anxiety scores, competency measurements, and one-on-one interviews to study the variables. ResultsPaired samples t-test of state anxiety scores showed a statistically significant increase from the baseline measurement to immediately after the simulated death. Large negative correlations were found between baseline resilience and state anxiety scores, and between baseline resilience and trait anxiety scores. Interview responses indicated that multiple factors lead to students experiencing stress and anxiety. ConclusionThe procedures and methods were appropriate for studying the variables. Correlations between resilience and anxiety scores indicated that maximum sampling variation may be beneficial when choosing interview participants.

Strategies to Develop Resilience: Lessons from a Civil Rights Activist, a Scientist, and an Astronaut.

Strategies to Develop Resilience: Lessons from a Civil Rights Activist, a Scientist, and an Astronaut.

Is there any effect of COVID-19 mRNA vaccination on electrocardiographic parameters in patients without apparent cardiovascular disease?

Objective: Electrocardiographic alterations were investigated following the second dosage of COVID-19 mRNA vaccination. Methods: A total of 260 individuals after two doses of COVID-19 vaccine with Pfizer-BioNTech were included in the study. The electrocardiographic parameters recorded at baseline and approximately one week later after two doses of Pfizer-BioNTech vaccine were compared for all patients. Results: PR interval was increased and QTc maximum interval was decreased significantly after second dose COVID-19 mRNA vaccination. Baseline and post-second dose vaccination states regarding P wave dispersion and QT dispersion/Tp-e interval which have been recognized to imply inhomogeneous atrial conduction and heterogeneity in ventricular repolarization were similar between groups. Conclusion: Our findings suggest that there should be no concern related to asymptomatic involvement of the myocardium subsequent the second dose of COVID-19 mRNA vaccination.

Effects of 24-h acute total sleep deprivation on physiological coupling in healthy young adults.

Sleep deprivation is associated with dysregulation of the autonomic nervous system, adverse cardiovascular events, cognitive and complex motor performance impairment. Less is known about the effects of acute total sleep deprivation (ATSD) on physiological coupling. We aimed to determine the effects of 24-h ATSD on the physiological coupling between complex subsystems by evaluating the cardiorespiratory, cardiovascular and cortico-cardiac interactions. This study enrolled 38 young healthy participants aged 23.2 ± 2.4 years. Multiple synchronous physiological signals including electrocardiography, photoplethysmography, bio-electrical impedance, electroencephalography, and continuous hemodynamic data, were performed over a baseline night after regular sleep and after a night with 24-h ATSD in the supine position. The magnitude squared coherence, phase synchronization index, and heartbeat evoked potential amplitudes, were obtained from 10-min synchronous physiological recordings to estimate the coupling strength between two time series. Parameters of hemodynamic characteristics and heart rate variability were also calculated to quantify autonomic regulation. Results indicated that the magnitude squared coherence (0.38 ± 0.17 vs. 0.29 ± 0.12, p = 0.015) between respiration and heart rate variability along with the magnitude squared coherence (0.36 ± 0.18 vs. 0.27 ± 0.13, p = 0.012) between respiration and pulse transit time were significantly decreased after 24-h ATSD. There were no significant differences (all p > 0.05) in phase synchronization indices, heartbeat evoked potential amplitudes as well as other analyzed measurements between baseline and 24-h ATSD states. We conclude that exposure to 24-h ATSD appears to weaken the cardiorespiratory and respiratory-cardiovascular coupling strength of young healthy adults. These findings suggest that physiological coupling analysis may serve as a complementary approach for characterizing and understanding the complex effects of sleep deprivation.

Baseline states of mind differentially affected diurnal salivary stress biomarkers: A preliminary study

The study aimed to determine how different baseline states of mind in each day (relaxed, ordinary, or stressful) affected the diurnal patterns of three commonly investigated salivary stress biomarkers: cortisol (sCort), alpha-amylase (sAA), and chromogranin A (sCgA). A total of 32 healthy volunteers collected saliva on three different mood days at six time points each day (awakening, 30 min after, 10:00, 12:00, 16:00, and 19:00 h). Pulse rates and subjective feeling of stress using a visual analog scale (VAS) were also recorded. The levels of sCort and sAA were highest on a stressful day at certain time points. The levels of sAA were lowest on a relaxing day in the afternoon. Surprisingly, sCgA levels showed an opposite pattern with the highest level seen on a relaxing day. Of note was that the majority of the participants chose a day during a meditation retreat as their relaxing day and participants practicing mindfulness manifested lower levels of sCort (p = 0.003) and sAA (p = 0.043) at 19:00 h compared with those choosing a general leisure day as their relaxing day. Different states of mind were associated with different courses of salivary stress biomarkers. sCort and sAA are the most reliable markers showing the expected trend with higher levels on a stressful day and lower levels on a relaxing day. While the current result cast doubt on the use of sCgA as a stress marker since it was the only marker that showed the opposite trend compared with those of the other two markers as well as pulse rates and VAS. Furthermore, this is the first study to demonstrate that mindfulness practice might have different effects on these biomarkers from just a general relaxed state of mind.

언어의 생산과 이해, 그리고 뇌의 예측성

The purpose of this paper is to argue that the theories of language production and comprehension adopt the predictive process of the brain. Predictive processes can be found in many domains of language: discourse, syntactic, semantic, and phonological domains. In the discourse domain, the predictive process is found in the conversations that take turns in about 200 milliseconds. Syntactically anomalous structures, e.g., garden-path sentences, elicit a large positive wave (P600), indicating the unexpectedness of the structure. Semantic prediction is exhibited in an evoked response (N400), whose amplitude is modulated when a given word is not congruous in a context. A phonological rule of a mother tongue also creates predictions about phonologically legal forms in pseudowords. The predictive mechanism of the brain is supported by neurological studies: Bar et al. (2007) show the default mode or baseline of the brain areas (Raichle et al. 2001) overlap with the regions activated by tasks that recruit associative processing. This means associative activation equals the process of the brain's baseline state. Bar et al. (2007) propose that continuous generation of predictions is derived from associative processes and analogical mapping of the brain. This study proposes that language production and comprehension theories employ this predictive process of the brain in that prediction seems to affect speech errors as well as implicature recovery.

Risk-based inspection applied to two-post above-ground automotive lifts

The safe use of two-post above-ground automotive lifts (2PAG lifts) has received particular attention in the province of Québec (Canada) following the death of a young mechanic. The inspection and preventive maintenance of this equipment is a problem highlighted in accident investigation reports and by representatives of the sector. Therefore, the work presented in this article aimed at proposing a complete and detailed inspection grid for 2PAG lifts by establishing an exhaustive list of verification criteria, baseline states and the inspection frequency for each criterion according to their criticality. The grid was built from standards, existing grids, manufacturers’ manuals, interviews and tests. The inspection frequency for each criterion was established using a decision-making algorithm, notably using the concepts of progressive and sudden failures as well as redundancy. Twenty-three of the 74 inspection criteria established in the grid require routine monitoring.

Geosite condition monitoring in the UK 1999–2019

Geosite condition monitoring makes an assessment or value judgement about the current condition of a geosite compared to a defined desired baseline state. Such work has been undertaken in the UK for over 20 years. The original framework for monitoring nationally and internationally important geosites, first implemented in 1999, has been trialled independently in each of the four UK conservation agencies (Natural England, Northern Ireland Environment Agency, NatureScot, Natural Resources Wales and their predecessor bodies). Different adaptations and insights to geosite condition monitoring have been made depending on devolved circumstances, but the ability to report results on a UK basis, using some shared common standards, has been retained. This paper assesses the geosite monitoring programme in the UK, identifies the commonalities and differences in approach across the four UK countries and compares the results produced. As a long-running and widely tested national geosite condition monitoring programme, the lessons learned from the UK may be applicable to any geosite monitoring programme globally.

Using water rights to identify groundwater density areas in the Sonora River basin

Justification: Although there is general information on the aquifers water balance, it is relevant to have methods to specify which are the most overexploited areas and for which kind of water use.Objective: This study identifies the areas with the highest density of groundwater use in the aquifers of the Sonora River basin.Methodology: The analysis is based on georeferencing 5,342 groundwater right titles, which are converted into areas using the Kernel density method.Results: Seven areas of high-medium density and 10 of medium density are identified. The volume of water and its main uses are estimated for each area.Limitations: Data time period correspond to June 2014.Value: The data time period may be an advantage for subsequent studies, since it provides information on the baseline state prior to the August 2014 mining spill. Conclusions: The method employed allows the identification of water stress areas and might help prevent the overexploitation of aquifers with high level of extraction.

Development and Evaluation of a Cloud Computing Adoption Framework (CCAFF) for Retail Banks in Bahrain

The Information Technology era supports the adoption of Cloud Computing (CC) on a large scale in many business fields, at which the Financial Institutions (i.e., Banking sector) is not an exception. Several gaps were found during an attempted literature reviewing. While several CC methods, strategies, or frameworks have been proposed or utilized for CC adoption in many economic sectors including the Financial institutes (FI)- Banking, it is still a relatively new initiative in many other countries including Bahrain. While Enterprise Architecture (EA) is claimed to be a leading information and business management discipline to develop an architecture that guides the transformation to CC adoption of an enterprise from a baseline state to a target state. However, there is an evident lack of scholarly articles on the development of CC adoption frameworks from EA perspective. Also, it was found that scholarly articles in the evaluation of CC adoption framework are scarce. To address those gaps, this paper aims at developing and evaluating a CCAFF for the CC adoption in Bahraini Banks by adapting a tailored version of the Open Group Architecture Framework (TOGAF) and embedding a tailored version of an enterprise cloud adoption strategy (ECAS) and then evaluating the CCAFF based on several criterions. A six phased Design Science Research Methodology (DSRM) is employed to design the research report, guide, and develop the CCAFF, while the exploratory nature of the research necessitates the employment of a holistic single Case Study strategy for an FI-01 bank, based on semi structured interviews and document analysis data collection techniques. Alongside, the data was analyzed using pattern matching technique. For the CCAFF evaluation, Delphi technique was employed at which seven experts in two rounded panels contribute to the evaluation findings based on six criterions. The evaluation findings demonstrated promising results in terms of ease of use (86.4%), usefulness (84.6%), decision making support (86.6%), comprehensiveness (85.8%), time efficiency (84.8%), and usage intention (84.8%).

Lombard Effect in Individuals With Nonphonotraumatic Vocal Hyperfunction: Impact on Acoustic, Aerodynamic, and Vocal Fold Vibratory Parameters.

This exploratory study aims to investigate variations in voice production in the presence of background noise (Lombard effect) in individuals with nonphonotraumatic vocal hyperfunction (NPVH) and individuals with typical voices using acoustic, aerodynamic, and vocal fold vibratory measures of phonatory function. Nineteen participants with NPVH and 19 participants with typical voices produced simple vocal tasks in three sequential background conditions: baseline (in quiet), Lombard (in noise), and recovery (5 min after removing the noise). The Lombard condition consisted of speech-shaped noise at 80 dB SPL through audiometric headphones. Acoustic measures from a microphone, glottal aerodynamic parameters estimated from the oral airflow measured with a circumferentially vented pneumotachograph mask, and vocal fold vibratory parameters from high-speed videoendoscopy were analyzed. During the Lombard condition, both groups exhibited a decrease in open quotient and increases in sound pressure level, peak-to-peak glottal airflow, maximum flow declination rate, and subglottal pressure. During the recovery condition, the acoustic and aerodynamic measures of individuals with typical voices returned to those of the baseline condition; however, recovery measures for individuals with NPVH did not return to baseline values. As expected, individuals with NPVH and participants with typical voices exhibited a Lombard effect in the presence of elevated background noise levels. During the recovery condition, individuals with NPVH did not return to their baseline state, pointing to a persistence of the Lombard effect after noise removal. This behavior could be related to disruptions in laryngeal motor control and may play a role in the etiology of NPVH. https://doi.org/10.23641/asha.20415600.

Commuter welfare-based probabilistic seismic risk assessment of regional road networks

This study integrates welfare, a measure of the impact of road network disruption on individual commuters’ well-being, with a probabilistic seismic risk assessment framework in a computationally tractable way. Welfare is a network performance measure that reflects the differential impacts of changes in commute time on various groups. For a case study of the San Francisco Bay Area, welfare loss is computed by augmenting an origin–destination matrix with publicly available information about commuters’ income levels, residences, and workplaces. While commuters from all income groups have similar risk of drivers’ delay due to road network disruption, commuters with low incomes have a substantially higher risk of welfare loss than those with high incomes. A comparison of bridge retrofit policies shows that disaggregation of welfare loss by income group is necessary to examine whether such policies reduce risk equitably. While a retrofit policy determined using drivers’ delay reduces the expected drivers’ delay, it increases the disparity in the per-capita welfare loss of commuters with low and high incomes relative to the network’s baseline state. In contrast, a retrofit policy that prioritizes low-income commuters reduces the difference in welfare loss of commuters with low and high incomes compared to the baseline network state.

Discussion

Discussion

SARS-CoV-2-specific T cells in unexposed adults display broad trafficking potential and cross-react with commensal antigens.

The baseline composition of T cells directly impacts later response to pathogens, but the complexity of precursor states remains poorly defined. Here, we examined the baseline state of SARS-CoV-2-specific T cells in unexposed individuals. SARS-CoV-2-specific CD4+ T cells were identified in pre-pandemic blood samples by class II peptide-MHC tetramer staining and enrichment. Our data revealed a substantial number of SARS-CoV-2-specific T cells that expressed memory phenotype markers. Integrated phenotypic analyses demonstrated diverse pre-existing memory states that included cells with distinct polarization states and trafficking potential to barrier tissues. T cell clones generated from tetramer-labeled cells cross-reacted with antigens from commensal bacteria in the skin and gastrointestinal tract. Direct ex vivo tetramer staining for one spike-specific population showed a similar level of cross-reactivity to sequences from endemic coronavirus and commensal bacteria. These data highlight the complexity of precursor T cell repertoire and implicate non-infectious exposures to common microbes as a key factor that shapes human pre-existing immunity to SARS-CoV-2.

Brain connectivity changes of propofol-induced altered states of consciousness using High-Density EEG Source Estimation.

Through source estimation, high-density electroencephalogram (EEG) signals at scalp level can be converted into signals at cerebral cortex level, which helps to measure cortical activity during anesthesia induced changes in consciousness level to explore the mechanism. In this research, the high-density EEG of propofol-induced consciousness states alterations in 20 healthy adults were converted into cortical signals of 68 regions of interest (ROI), after alpha bandpass filtering, the pairwise orthogonal power envelope connectivity (PEC) was calculated. Then, due to the number of PECs was huge, the least absolute shrinkage and selection operator (LASSO) was used to select as few PECs as possible as the indicators to distinguish baseline (BS) and moderate sedation (MD) states. The results show that most PECs that can be used as indicators are related to ROI related to default mode network (DMN). At the same time, changes of thalamocortical connectivity and frontal-parietal connectivity could be observed, similar to the neuroimaging method of directly measuring cerebral cortical activity. By extracting the PEC as a classifier to classify the BS and MD States, the accuracy could reach more than 70%. Therefore, this method can not only reflect the mechanism of cortical activity alterations induced by anesthetics, but also provide a new idea for monitoring the depth of anesthesia in the future. Clinical Relevance - This shows that the high-density EEG of scalp level can be converted into cortical signals by source estimation, which is similar to the neuroimaging method of directly measuring cortical activity.

Simple gene signature to assess murine fibroblast polarization

We provide an original multi-stage approach identifying a gene signature to assess murine fibroblast polarization. Prototypic polarizations (inflammatory/fibrotic) were induced by seeded mouse embryonic fibroblasts (MEFs) with TNFα or TGFß1, respectively. The transcriptomic and proteomic profiles were obtained by RNA microarray and LC-MS/MS. Gene Ontology and pathways analysis were performed among the differentially expressed genes (DEGs) and proteins (DEPs). Balb/c mice underwent daily intradermal injections of HOCl (or PBS) as an experimental murine model of inflammation-mediated fibrosis in a time-dependent manner. As results, 1456 and 2215 DEGs, and 289 and 233 DEPs were respectively found in MEFs in response to TNFα or TGFß1, respectively. Among the most significant pathways, we combined 26 representative genes to encompass the proinflammatory and profibrotic polarizations of fibroblasts. Based on principal component analysis, this signature deciphered baseline state, proinflammatory polarization, and profibrotic polarization as accurately as RNA microarray and LC-MS/MS did. Then, we assessed the gene signature on dermal fibroblasts isolated from the experimental murine model. We observed a proinflammatory polarization at day 7, and a mixture of a proinflammatory and profibrotic polarizations at day 42 in line with histological findings. Our approach provides a small-size and convenient gene signature to assess murine fibroblast polarization.

Biopsychosocial Contributors to Parent Behaviors during Child Venipuncture.

Children’s needle-related distress is strongly related to parental verbal behaviors. Yet, empirical data supporting theorized contributors to parent behaviors in this context remain limited. This is the first study to collectively measure biological (heart rate variability; HRV), psychological (catastrophizing, anxiety), and social (child behaviors) contributors to parent verbal behaviors throughout pediatric venipuncture. HRV was used as a measure of emotion regulation capacity and examined as a moderator in the associations between parent psychological factors and their behaviors, and between child and parent behaviors. Sixty-one children aged 7 to 12 years who presented at an outpatient blood lab for venipuncture and a parent participated. Parent baseline HRV, state catastrophizing, and anxiety were measured prior to venipuncture. The procedure was video-recorded for later coding of pairs’ verbal behaviors. Strong associations emerged between child behaviors and parent behaviors. Baseline HRV moderated the association between parent catastrophizing and behavior. Social factors remain a strong influence related to parent behaviors. Psychologically, parent negative cognitions differentially related to parent behaviors based on their emotion regulation capacity. Biologically, low baseline HRV may increase the risk that certain parents engage in a constellation of behaviors that simultaneously direct their child’s attention toward the procedure and inadvertently communicate parental worry, fear, or concern.

Abstract 618: Discovery of predictive biomarkers of response to T cell-targeting biologics using ex vivo single-cell profiling coupled with TCR clonotype characterization

Abstract The discovery of predictive biomarkers of response is critical for forecasting patient benefit from novel immune-modulatory therapeutics. However, their discovery is hindered by the complexity of the drug modes of action and the lack of adequate biological models. We designed an approach to define biomarkers of response by subjecting dissociated tissue from human tumors to T cell-targeting biologics or their combinations, followed by single-cell transcriptomic profiling and TCR clonotype characterization. Responding cells are identified as those showing treatment-specific shifts in gene expression profiles. Specifically for T cells, TCR clonotypes can be used to match responding T cells in treatment conditions to their sister clones in the baseline state. Comparing the baseline gene expression profiles between T cell clonotypes that responded to the treatment and those that did not allows the discovery of gene expression signatures that can predict response. We processed over 20 tumor samples obtained from cancer patients and treated them ex vivo with two novel biologics currently under clinical development - HFB301001, a potentially best-in-class 2nd generation OX40 agonist, and HFB200301, a potentially first-in-class TNFR2 agonist. We applied our biomarker discovery strategy to the pooled scRNA-seq and scTCR-seq data from these samples to define predictive signatures of response to these drugs. To further validate this strategy, we also generated single-cell data in our ex vivo system to characterize response to anti-PD-1 treatment. In the anti-PD-1 predictive response signature, we identified genes involved in inflammatory response and genes in the pathway of other co-inhibitory checkpoints. Application of the anti-PD-1 predictive response signature to bulk transcriptomic data from clinical studies with checkpoint inhibitors successfully stratified patients into two groups with significantly different risk of progression. The predictive response signatures for the two novel agonistic antibodies shared genes involved in inflammatory pathway with the anti-PD-1 signature, but also contained other distinct gene sets. Application of these predictive response signatures to bulk transcriptomic data from TCGA was able to stratify patients across cancer indications by predicted likelihood of response to individual treatments or combinations. The predictive biomarkers of response for the novel OX40 and TNFR2 agonist antibodies will be validated in our Phase I clinical trials. Ex vivo single-cell profiling coupled with TCR clonotype characterization enabled the discovery of predictive response signatures that informed patient selection strategies for the early clinical development of novel therapeutics. Citation Format: Dean Lee, Monika Manne, Roshan Kumar, Rebecca Silver, Alexandra Staskus, Julianna Crivello, Zhiyuan Wang, Dohyun Lee, Ross Fulton, Zhizhan Gu, Christos Hatzis, Francisco Adrian, Andreas Raue, Liang Schweizer. Discovery of predictive biomarkers of response to T cell-targeting biologics using ex vivo single-cell profiling coupled with TCR clonotype characterization [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 618.

#34 Evaluation of surgical antibiotic prophylaxis at tertiary level pediatric hospital in Mexico City

Abstract Background There is certainty that surgical antibiotic prophylaxis is useful in the prevention of surgical site infection. However, it should be chosen with a spectrum aimed at microorganisms that, due to the type of surgery, could cause an infection and reduce events should be prescribed at correct doses and with the minimum duration. Surgical services are in constant change, it seems that the demands on the personal physician to be in the surgery room and to attend to those worrisome needs of the patient make the responsibility for making decisions about antibiotics uncoordinated. For this reason, the prescription of antimicrobials can be perceived as a secondary task and one that is even delegated to young surgical members. The objective of this study was to describe the most frequent errors in surgical prophylaxis prescription. Method This is an analytic transverse study in a six-month period (November 2020-March2021), that includes antibiotic prescriptions on surgical departments (orthopedics, general surgery, urology, plastic surgery, neurosurgery, oncologic surgery, otorhinolaryngology). For variable analysis, a Chi-square test, odds ratio and etiological fraction among exposed will be performed. Results 423 antibiotic prescriptions were analyzed, 210 achieved inclusion criteria and 190 were indicated as surgical antibiotic prophylaxis, 118 of these have at least one error in prescription. The odds ratio for prescription errors and the indication of antibiotics as prophylaxis (Pearson chi square test 16.442 p 0.00) were 9.29 (CI 95% 2.63-32.8), etiological fraction among exposed were 89.23%. Table 1 shows surgical antibiotic prescriptions for services in descending order, although the patients were from surgery services, the prescriptions were not always made form the same service (for example anesthesiology) and the number error prescriptions to show which areas should be trained in prescribing antibiotics. The most frequent errors in the initial prescription of antibiotics that were documented corresponded to not indicating the time of administration of the antibiotic in the case of surgical prophylaxis and dosage. After applying the “Time out” strategy, the most documented error was the prolongation of antibiotic prophylaxis. The most frequently prescribed pharmacological group of antibiotics corresponded to cephalosporins. Conclusion Antimicrobial education or restriction strategies are required to correct the high percentage of errors observed in antibiotic prescriptions. Knowing this baseline state is the initial step for the formulation of antimicrobial use optimization programs that reduce adverse events, costs, and local antimicrobial resistance rates. Despite having statistically significant data between prescription errors and the indication of antibiotics as prophylaxis, the heterogeneity of the services prescribed does not make a conclusion of the probability of occurrence of the event possible, however it shows the services that need more training in the prescription of antibiotics.